Qualitative study of general practitioners’ perceptions and experiences | BMJ Open
Liver disease is the third most common cause of premature death in the UK. The symptoms of terminal liver disease are often difficult to treat, but very few patients see a palliative care specialist and a high proportion die in hospital. Primary care has been identified as a setting where knowledge and awareness of liver disease is poor. Little is known about general practitioners’ (GPs) perceptions of their role in managing end-stage liver disease.
GPs expressed a desire to be more closely involved in end-of-life care for patients with liver disease but identified a number of factors that constrained their ability to contribute. These fell into three main areas; those relating directly to the condition, (symptom management and the need to combine a palliative care approach with ongoing medical interventions); issues arising from patients’ social circumstances (stigma, social isolation and the social consequences of liver disease) and deficiencies in the organisation and delivery of services. Collaborative working with support from specialist hospital clinicians was regarded as essential, with GPs acknowledging their lack of experience and expertise in this area.
Full reference: Standing, H. et al. (2017) How can primary care enhance end-of-life care for liver disease? Qualitative study of general practitioners’ perceptions and experiences. BMJ Open. 7:e017106.
Elliott, M. & Nicholson, C.A. (2017) BMJ Supportive & Palliative Care. 7:32-38.
Objective: The question “Would you be surprised if this patient were to die in the next 6–12 months?” has been included in UK palliative care guidance with the aim of supporting the identification and care planning of those nearing the end of life. Little is known about how the surprise question is utilised in the care of older people within primary care. This study sought to explore the perceptions and experiences of general practitioners (GPs).
Conclusions: Greater understanding is needed as to the difficulties experienced by GPs when assessing prognosis in older people. We propose a thematic model which could support GPs by focusing assessment on the supportive and palliative care needs of older people nearing the end of life.
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Dunphy, E. J. et al. End-of-life planning with frail patients attending general practice: an exploratory prospective cross-sectional study British Journal of General Practice. 2016 e661-e666
Background: End-of-life planning means decision making with patients, formulating and recording decisions regarding their end-of-life care. Although clearly linked with benefits including improved quality of life, reduced hospital admissions, and less aggressive medical care, it is still infrequently undertaken and is regarded as challenging by healthcare professionals.
Aim: To ascertain the feasibility of improving the identification of patients at high risk of dying in general practice and the acceptability of providing patients identified with an end-of-life planning tool.
Design and setting: Exploratory prospective cross-sectional study in four general practices.
Method: Patients at high risk of dying were identified during routine consulting by their GP, using the Supportive and Palliative Care Indicators Tool (SPICT). Patients identified were invited to participate, and provided with Think Ahead — an end-of-life planning tool, which has been used previously in general practice. Participants completed telephone surveys, assessing their response to Think Ahead, and the acceptability of the GP raising end-of-life issues during routine consulting.
Results: Provision of Think Ahead to a purposive sample of preterminal patients identified by GPs was feasible, acceptable to most patients, and somewhat effective in increasing discussion among families and in practice on end-of-life planning.
Conclusion: The SPICT and Think Ahead tools were mostly acceptable, effective, and enabling of discussions on end-of-life care in general practice.
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Mitchell, S. et al. Providing end-of-life care in general practice: findings of a national GP questionnaire survey. British Journal of General Practice. 2016 Aug; 66 (650): e647-e653
Background: With increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of high-quality palliative and end-of-life care (EOLC).
Aim: To provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care.
Design and setting: A web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs.
Method: Responses were analysed using descriptive statistics and an inductive thematic analysis.
Results: Responses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care — which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors — with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management — including effective symptom-control and access to specialist palliative care services; and expertise and training — the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC.
Conclusion: The findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care.
Palliative care is a core part of the role of a GP. It can and should begin as early as possible in a patient’s course of illness, but as GPs we may individually become involved at a variety of points without necessarily having had the opportunity to build a prior relationship with a patient. This can be challenging, particularly if seeing a patient for the first time when they are in the last days of life. This article aims to explore the different points at which palliative care may begin and summarise new guidance that may inform management.
Reference: InnovAiT: Education and inspiration for general practice. Published online before print May 12, 2015